The results were presented at a press conference held on Thursday October 29 by the French National Union of ENT specialists (SNORL) and the National Union of Hearing Aid Specialists (Unsaf), with the participation of Prof. Hélène Amieva, who represented the team from Bordeaux. Last year, the team presented results showing a relationship between hearing loss and cognitive decline, thus confirming the findings of research carried out by Prof. Frank Lin, and reinforcing these data since the longitudinal study in France covered a period of 25 years, versus six years for the American team.

Recent findings that support screening and rehabilitation of hearing disorders in elderly people

Comparative results between groups of subjects have shown that those who have hearing loss and who do not use hearing aids had a significantly higher cognitive decline, based on MMSE tests, than those without a hearing disorder, over 25 years of follow-up. The Mini-Mental State Examination developed by Folstein et al. is a common test used to assess a person’s cognitive and mental state. By contrast, declines demonstrated by MMSE tests in groups of subjects with hearing loss, but who use hearing aids, were not different from those of the control group made up of people with no hearing problems.

This study confirms that cognitive decline is increased in elderly people with hearing loss. Hearing impairments are generally associated with increased symptoms of depression and gradual social isolation.

The findings also suggest, for the first time, that rehabilitation of hearing loss with hearing aids helps to prevent a higher level of cognitive decline in subjects with hearing loss, compared to people who have no hearing difficulties.

Wearing hearing aids thus appears to have a positive effect on cognition by restoring communication abilities, and promoting social cohesion and quality of life.

“These results argue in favor of screening and rehabilitation of hearing disorders in elderly people,” said Prof. Amieva at the press conference. “We now have a set of data that is sufficiently robust to assert that hearing loss induces accelerated cognitive decline in the elderly. In addition, and for the first time, findings suggest that using hearing aids helps to attenuate this decline. Hearing impairments are generally associated with increased symptoms of depression and gradual social isolation. Wearing hearing aids thus appears to have a positive effect on cognition by restoring communication abilities, and promoting social cohesion and quality of life. People with hearing loss who have hearing aids do not present this higher cognitive decline, but appear to have a similar level of decline as elderly people with no hearing problems. And this finding is completely new! Also, more generally, our results show that along with other prevention strategies, such as physical exercise and a Mediterranean-type diet, maintaining healthy hearing should be one of the strategies used to promote “successful aging”. It seems that the PAQUID cohort will continue to bring us very important results, particularly in the area of hearing. Our Inserm team in Bordeaux is working on the epidemiology of aging, cognition in particular, and has been for many years. We are looking into many different factors, whether biological, genetic, environmental, or psychosocial, that are involved in cognitive decline at a given point in time. We recently started paying closer attention to hearing – we are in fact not audiology specialists by training – and I think that the results of this study are very encouraging and mean that we should go much further in this area! I am now thinking about the link there may be between hearing loss and loss of autonomy and entry into care institutions, along with all the consequences on health that are well known in aging and that are a concern to us all. The possibilities opened up by PAQUID are immense. Among the avenues of research, we specifically hope to show in time what links there are between hearing loss and mortality.”

What is PAQUID?

The PAQUID study – Inserm U 897, Epidemiology and biostatistics, Bordeaux – is a population cohort established in 1988 for very long-term follow-up (25 years so far) of 3,777 elderly people aged 65 years or over in 75 cities and towns in Gironde and Dordogne, south west France. The main objective of PAQUID was the epidemiological study of cognitive and functional aging in the general population, particularly the epidemiology of Alzheimer’s disease and related diseases, but also the epidemiology of dependence in elderly subjects. Participants were examined eleven times, about every two years, with repeated testing of cognition, collection of functional scale data, and systematic detection of dementia. PAQUID provided the first estimates of the prevalence, incidence, and mean duration of the disease in the general population. The cohort was used to study the multiple risk factors of Alzheimer’s and related disorders, including age, sex, level of education, consumption of wine and tobacco, recreational activities, etc., along with the natural history of the prodromal phase of the disease, over more than ten years. PAQUID has shown that dementia was by far the main cause of dependence in elderly people. It has also shown that cognitive decline is higher in elderly people who have hearing loss, compared to those who do not have trouble hearing.

As a reminder, an American study by Prof. Frank Lin (Johns Hopkins School of Medicine, Baltimore, MD) published in 2013 in the journal JAMA, that included 1,984 patients with a mean age of 77 years, arrived at the conclusion that hearing loss without correction was associated with an acceleration of cognitive decline in people living in retirement homes.

There are now 11 million people (one in six) in the UK living with hearing loss according to a new report from the national charity Action on Hearing Loss (formerly RNID), with the number increasing to one in five people (15.6 million) by 2035, due to an ageing population. At the same time, hearing loss is the only area that has seen a decrease in medical research funding during the last decade. The charity is urgently calling on the government to stop hearing aid cuts and protect and safeguard the provision of hearing aid services which offer a lifeline to many.

The new report, Hearing Matters, comprehensively details the scale and impact of deafness, tinnitus and hearing loss, demonstrating to NHS commissioners and employers the prevalence and need to tackle it as a major public health condition, in order for them to plan to meet the needs of the increasing number of people with hearing loss so that they are not denied the same rights and opportunities as everyone else.

Key report findings:

· Less than 1% of medical research funding is spent on hearing loss – which is the equivalent of just £1.11 for every person affected, in comparison; £11.35 was spent on sight loss for every person affected and £19.79 on research into cardiovascular conditions.

· On average, people often take 10 years to seek help for their hearing loss, with evidence suggesting GPs fail to refer 45% of people reporting hearing problems for any intervention – which research shows can lead to communication difficulties and isolation.

· Hearing loss doubles the risk of developing depression and can lead to anxiety and other mental health conditions.

· People with mild hearing loss face double the risk of developing dementia, with moderate hearing loss leading to three times the risk and severe hearing loss five times the risk of developing dementia.

· In 2013 the UK economy lost more than £24.8 billion in potential output because people with hearing loss were unable to work.

· If low employment rates for people with hearing loss are not addressed, by 2031 the UK economy will lose £38.6 billion a year.